Evidence-Based Practice and Mobile Apps : continuing education classes at the MLGSCA/NCNMLG Joint Meeting in San Diego

Hella Bluhm-Stieber

Hella Bluhm-Stieber

I attended the Joint Meeting in La Jolla and took 2 CE classes. The first one was given by Connie Schardt, who is the authority on Evidence-based practice and is still teaching classes even though she is retired. She showed and explained us the criteria for judging the validity of therapy studies and studies of diagnostic tests. She also went over the differences between quantitative and qualitative studies. 

After reviewing the basics, e.g. using PICO to focus your search, use clinical queries as filter in PubMed, check retrieval for bias, we looked at actual research articles. For the therapy study we needed to look for randomization of patients, if patients in the treatment and control group were similar at baseline, how to find out who was blinded, if treatment and control groups were treated equally, if follow-up was complete, etc. Connie used the acronym FRISBE (Follow-up complete, Randomization, Intention to treat, Similar at baseline, Blinding, Equal treatment).

After that we looked at the results of the study and calculated the experimental event rate, the control event rate, the absolute benefit increase and the relative benefit increase. The absolute benefit shows  exactly what the difference is, the relative shows us the percentages. She mentioned that reporters often use the relative benefit since it is a bigger number and makes you feel that the intervention helped more.

For the diagnosis study, we looked at a study and the answers to the following questions: 1. did participating patients present a diagnostic dilemma, 2. did investigators compare the test to an appropriate, independent reference standard, 3. were those interpreting …blind to other results, 4. did investigators perform the same reference standard to all patients regardless of the results of the test under investigation? We then looked at the results and calculated the sensitivity and specificity, and likelihood ratios for positive and negative tests.

Connie explained the differences between qualitative and quantitative studies. Quantitative methods test hypotheses and are deductive, qualitative methods generate hypotheses and are inductive. Quantitative are e.g. randomized clinical trials, epidemiologic data, and close-ended surveys. Qualitative methods are in-depth interviews, focus groups, field observation, etc. We looked at two studies, and were able to find problems with one of them, since it had not received IRB approval and they had only 2 participants, also it was not clear how often and long they interviewed the participants.

This class helped me understand research articles better and showed me what and where to look for when evaluating a study.

The second class I took was on Mobile App Therapy and Mobile devices in libraries. Gabe Rios from the University of Alabama at Birmingham and Bart Ragon from the University of Virginia provided us with lots of background, trends on mobile devices and usage, usage in libraries, and practical tips for apps. They encouraged us to find out from our users, which apps they are using and to offer classes, e.g. 50 apps in 50 minutes. Gabe is regularly teaching such a class, and he not only features clinical and reference apps, but also cooking and travel apps to create interest.

Some libraries loan out mobile devices, and some preload them with certain apps. One can find sample policies online, e.g. University of Utah http://library.med.utah.edu/or/technologies.php . Some institutions provide free mobile devices to the medical students or library staff so that they can play around with them and get familiar with them. Other institutions do not even allow personal mobile devices, which makes it difficult for librarians to help their users.

If you want to get started lending mobile devices in your library, you need to commit time and personnel, create very clear policies, install apps, get feedback (short survey about likes/dislikes, apps), use devices for collection development, barcode everything, get a bag and cover for the iPad.

Gabe also talked about making your website mobile. Easy ways to convert are Usablenet Transcoder at http://transcoder.usablenet.com/tt/index.html and the Google mobile optimizer http://www.google.com/gwt/n .

Gabe and Bart also talked about apps that are research tools. There are different version of PubMed: PubMed On Tap, PubMed CLIP, PubMed for Handhelds, PubMed Mobile. PubMed Mobile is for  Android, UnboundMedline for iOS and Android supports EZ proxy and LInkResolvers, PubMed by MedFetch for Android has EZProxy support. Pubget searches PubMed and your favorite journals and let you save papers to read offline. Other Research tools are: Medline Plus Mobile, NIH Apps, Essential Evidence, Visual DX, Ebsco Mobile, and apps for specific journals, e.g. NEJM (free for iPhone and iPad). Scopus lets you search all of Elsevier’s journal using the ScienceDirect App.

There are general productivity apps like Dropbox, Evernote, Quick Office Pro (Android), iWorks Apps. Other productivity apps are for note taking (PaperPort, Penultimate, Notability, Pear Note), for PDF reading (PDF Expert 4, iAnnotate PDF, Goodreader), for article management (Read reviews, Papers, Sente Reference Manager,  Mendeley), and for scanning (QR Droid, Google Goggles, QR Reader, Red Laser, NeoReader),

Bart talked about some clinical apps. The iTunes store has a section for “Health Professionals”, but it is difficult to find. iMedicalApps reviews medical apps and publishes monthly lists of the 20 best free medical apps for different devices, e.g. http://www.imedicalapps.com/2013/06/free-iphone-medical-apps-physicians/ . Some of the clinical apps are: Medscape (free), Epocrates (Only RX is free), Micromedex Drug Information (free), Hopkins Guide (antibiotics), Uptodate (need to reregister every 3 months). There are also many medical education apps, e.g.  to learn anatomy, Dr Chrono for EMR and patient monitoring, apps for direct and secure connections to the EMR. Some apps can be used in connection with heart monitors. There are apps for nurses, e.g. Nursing Central, NurseTabs, Lab Values Reference, Shots by STFM, and NCSBN’s RX flash cards.

Other apps are for patient education, consumer health (weight loss and diet, wellness resources, exercise and fitness), some work together with wearable technology/tracking device).  At the end we briefly talked about how to evaluate an app.

I learned a lot from these two classes and would recommend them both.

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